A Guide to Obsessive Compulsive Disorder

Transcription

1 A Guide to Obsessive Compulsive Disorder

2

3 Obsessive compulsive disorder (OCD) is a common mental health problem. Symptoms typically include recurring obsessive thoughts, and repetitive compulsions in response to the obsession. A common example is recurring obsessive thoughts about germs and dirt, with a compulsion to wash your hands repeatedly to clean off the germs. However, there are many other examples. The usual treatments are cognitive behaviour therapy, a selective serotonin reuptake inhibitor (SSRI) antidepressant medicine, or both. Treatment often works well to reduce the symptoms and distress of OCD greatly.

4 Niamh A Guide to Obsessive Compulsive Order What is obsessive compulsive disorder? OCD is a condition where you have recurring obsessions, compulsions, or both. What are obsessions? Obsessions are unpleasant thoughts, images, or urges that keep coming into your mind. Obsessions are not simply worries about your life problems. Common obsessions include: Fears about contamination with dirt, germs, viruses (eg HIV), etc. Worries about doors being unlocked, fires left on, causing harm to someone, etc. Intrusive thoughts or images of swearing, blasphemy, sex, someone harmed, etc. Fear of making a mistake or behaving badly. A need for exactness in how you order or arrange things. These are examples. Obsessions can be about all sorts of things. Obsessive thoughts can make you feel anxious or disgusted. You normally try to ignore or suppress obsessive thoughts. For example, you may try to think other thoughts to neutralise the obsession. What are compulsions? Compulsions are thoughts or actions that you feel you must do or repeat. Usually the compulsive act is in response to an obsession. A compulsion is a way of trying to deal with the distress or anxiety caused by an obsession. For example, you may wash your hands every few minutes in response to an obsessional fear about germs. Another example is you may keep on checking that doors are locked in response to the obsession about doors being unlocked. Other compulsions include repeated cleaning, counting, touching, saying words silently, arranging and organising - but there are others.

5 niamhwellbeing.org How does obsessive compulsive disorder affect your life? The obsessions that you have with OCD can make you feel really anxious and distressed. The compulsions that you have may help to relieve this distress temporarily but obsessions soon return and the cycle begins again. The severity of OCD can range from mildly inconvenient, to causing severe distress. You know that the obsessions and compulsions are excessive or unreasonable. However, you find it difficult or impossible to resist them. OCD affects people in different ways. For example, some people spend hours carrying out compulsions and, as a consequence, cannot get on with normal activities. Some people do their compulsions over and over again in secret (like rituals ). Other people may seem to cope with normal activities, but are distressed by their recurring obsessive thoughts. OCD can affect your work (or school-work in children), relationships, social life, and your quality of life. Many people with OCD do not tell their doctor or anyone else about their symptoms. They fear that other people might think they are crazy. Some people with OCD may feel ashamed of their symptoms, especially if they contain ideas of harming others, or have a sexual element. As a result, many people with OCD also become depressed. However, if you have OCD, you are not crazy or mad. It is not your fault and treatment often works. If you are concerned that you may be depressed (for example if you have been feeling very down and you no longer take pleasure in the things that you used to enjoy) you should see your doctor. What causes obsessive compulsive disorder? The cause of OCD is not clear. Slight changes in the balance of some brain chemicals (neurotransmitters) such as serotonin may play a role. This is why medication is thought to help (see below). Also, the chance of developing OCD is higher than average in first-degree relatives of affected people (mother, father, brother, sister, child). So, there may be some

6 Niamh A Guide to Obsessive Compulsive Order genetic element to OCD. However, so far, no genes have been found to be linked with OCD. Other theories about the cause of OCD have been suggested, but none proved. Who gets obsessive compulsive disorder? It is thought that between 1 to 3 in 100 adults have OCD. Anyone at any age can develop OCD but it usually first develops between the ages of 18 and 30. About 2 in 100 children are also thought to have OCD. OCD is usually a chronic (persistent) condition. How is obsessive compulsive disorder diagnosed? If you are concerned that you may have obsessive compulsive disorder, you should see your doctor and explain your concerns. They may start by asking some of the following questions. These questions can act as a screen for possible OCD: Do you wash or clean a lot? Do you check things a lot? Is there any thought that keeps bothering you that you would like to get rid of, but cannot? Do your daily activities take a long time to finish? Are you concerned about putting things in a special order, or are you upset by mess? Do these problems trouble you? A more detailed assessment is then needed for obsessive compulsive disorder to be diagnosed. This may either be carried out by your doctor or by a specialist mental health team. The assessment will look at any obsessional thoughts and compulsions that you have and how they affect you and your daily life. Children with OCD may be referred to a specialist mental health team which is experienced in assessing and treating children with OCD.

7 niamhwellbeing.org What is the treatment for obsessive compulsive disorder? The usual treatment for OCD is: Cognitive behaviour therapy (CBT), or Medication, usually with an SSRI antidepressant medicine, or A combination of CBT plus an SSRI antidepressant medicine. Cognitive behaviour therapy What is CBT? CBT is a type of specialist talking treatment (a specialist psychological therapy). It is probably the most effective treatment for OCD. Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as OCD. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have. Also to help your thought patterns to be more realistic and helpful. For example, if you have OCD it may be helpful to understand that thoughts or obsessions in themselves do no harm, and you do not have to counter them with compulsive acts. The therapist suggests ways in which you can achieve these changes in thinking. Behaviour therapy aims to change behaviours which are harmful or not helpful. For example, compulsions. The therapist also teaches you how to control anxiety when you face up to any feared situations. For example, by using breathing techniques. Cognitive behaviour therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours. This is the most common treatment for OCD. A particular variation of CBT called exposure and response prevention is often used for OCD. For example, say you have a compulsion to keep washing your hands in response to an obsessional fear about contamination with germs. In this situation the therapist may gradually expose you to contaminated objects. But, the therapist prevents you from doing your usual compulsion (repeated hand washing) to ease your anxiety about contamination. Instead, the therapist teaches you how to control any anxiety in other ways. For example, by using deep breathing techniques. In time, you should become less anxious about contamination and feel less need to wash your hands so much.

8 Niamh A Guide to Obsessive Compulsive Order How can I get CBT? Your doctor may refer you to a therapist who has been trained in CBT. This may be a psychologist, psychiatrist, psychiatric nurse, or other healthcare professional. There is a limited number of CBT therapists available on the NHS and there may be waiting lists for therapists in some areas. However, government policy is to make CBT more widely available on the NHS. Therapy is usually weekly sessions of about minutes each, for several weeks. Sometimes this is done in a group setting or sometimes one-to-one, depending on various factors such as the severity of the problem. Sometimes, CBT is done by telephone conversations with a therapist. How effective is CBT for OCD? Of those who complete a course of CBT, there is a marked improvement in more than 3 in 4 cases. Symptoms may not go completely, but usually the obsessions and compulsions become much less of a problem. About 1 in 4 people with OCD finds CBT too stressful and not for them. However, cognitive therapy alone may help some people who find the full CBT too stressful. Do-it-yourself CBT CBT with the help of a trained therapist is best. However, some people prefer to tackle their problems themselves. There is a range of self-help books and leaflets on self-directed CBT. More recently, interactive CDs and websites are being developed and evaluated for self-directed CBT. See the resources below for further details. Medicines used to treat obsessive compulsive disorder SSRI antidepressants Although they are often used to treat depression, SSRI antidepressant medicines can also reduce the symptoms of OCD, even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin, which may be involved in causing symptoms of OCD. SSRI antidepressants include: citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.

9 niamhwellbeing.org Note: SSRI antidepressants do not work straight away. It takes 2-4 weeks before their effect builds up and start to work. They may take up to 12 weeks to work fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work. SSRI antidepressants are not tranquillisers, and are not usually addictive. The doses needed to treat OCD are often higher than those needed for depression. If it works, it is usual to take an SSRI antidepressant for at least a year to treat OCD. What about side-effects with SSRIs? Most people who take an SSRI have either minor, or no, side-effects. Possible side-effects vary between different preparations. The most common ones include: diarrhoea, feeling sick, vomiting, and headaches. Some people develop a feeling of restlessness or anxiety (see below). Sexual problems sometimes occur. It is worth keeping on with treatment if sideeffects are mild at first. Minor side-effects may wear off after a week or so. The leaflet that comes in the medicine packet gives a full list of possible sideeffects. Tell your doctor if a side-effect persists or is troublesome. A switch to a different preparation may then suit you better. Drowsiness is an uncommon side-effect with SSRI antidepressants, but do not drive or operate machinery if you become drowsy whilst taking one. SSRI antidepressants and suicidal behaviour In recent years there have been some case reports which claim a link between taking SSRI antidepressants and feeling suicidal. The Committee on Safety of Medicines has recently reviewed the evidence on whether there is such a link. They were unable to find any convincing evidence of this link. The Committee on Safety of Medicines has stated that it will continue to monitor this issue.

10 Niamh A Guide to Obsessive Compulsive Order Because of this possible link, see your doctor promptly if you become restless, anxious or agitated, or if you have any suicidal thoughts. In particular, if these develop in the early stages of treatment with an SSRI, or following an increase in dose. Are SSRI antidepressants addictive? SSRIs are not tranquillisers, and are not thought to be addictive. (This is disputed by some people, and so this is controversial. If addiction does occur, it is only in a minority of cases.) Most people can stop an SSRI without any problem. At the end of a course of treatment you should reduce the dose gradually over about four weeks before stopping. This is because some people develop withdrawal symptoms if the SSRI is stopped abruptly. Withdrawal symptoms that may occur include: dizziness, anxiety and agitation, sleep disturbance, flu-like symptoms, diarrhoea, abdominal cramps, pins and needles, mood swings, feeling sick, and low mood. These symptoms are unlikely to occur if you reduce the dose gradually. If withdrawal symptoms do occur, they will usually last less than two weeks. An option if they do occur is to restart the medicine, and then reduce the dose even more slowly before stopping. You should see your doctor if you are worried that you are developing withdrawal symptoms. Some other points about SSRIs and OCD Symptoms can improve by up to 70% if you take an SSRI. So, although symptoms may not go completely, they usually greatly improve so the obsessions and compulsions are much less of a problem. This can make a big difference to your quality of life. You should not stop SSRI antidepressants suddenly. You should gradually reduce the dose as advised by a doctor at the end of treatment. In some people the symptoms return when medication is stopped. An option then is to take an SSRI antidepressant long-term. However, symptoms are less likely to return once you stop an SSRI antidepressant if you have had a course of CBT (described earlier).

11 niamhwellbeing.org Reasons why medication may not work so well in some people include: The dose is not high enough and needs to be increased. Medication was not taken for long enough - it may take up to 12 weeks to work. Side-effects became a problem and so you may stop the medication. Tell a doctor if side-effects are troublesome. Other medicines that are used to treat obsessive compulsive disorder If SSRIs do not help much, or cannot be taken, then another type of antidepressant called clomipramine is sometimes used. This is classed as a tricyclic antidepressant and used to be the main medication treatment for OCD before SSRIs became available. Occasionally, other medicines that are used to treat mental health disorders are used. Cognitive behaviour therapy plus selective serotonin reuptake inhibitor antidepressants In some situations, a combination of CBT plus an SSRI antidepressant is advised. This may be better than either used alone when OCD is severe. What is the prognosis (outlook) for obsessive compulsive disorder? If OCD is not treated, obsessive thoughts and compulsions may not improve and may get worse in some people. However, with treatment many people s symptoms can be brought under control and some people may be completely cured. If you have OCD, there is a risk that it can return even after successful treatment and recovery. If your symptoms do come back, be sure to see a doctor for further treatment.

13 niamhwellbeing.org British Association of Behavioural and Cognitive Psychotherapies (BABCP) Victoria Buildings, 9-13 Silver Street Bury BL9 0EU Telephone Maintain a register of practitioners so that you can find a Cognitive/Behavioural Therapist in your area. They also have information about frequently encountered problems including Anxiety, Depression and OCD. Oxford Cognitive Therapy Centre (OCTC) Based in the Oxford Psychology Dept, part of Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust. Their website gives details of how to order a number of educational and self-help booklets with a CBT approach for conditions including Obsessive- Compulsive Disorder. References Obsessive-compulsive disorder, Clinical Knowledge Summaries (November 2008) Obsessive Compulsive Disorder, NICE (2005); (Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder) Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitor Antidepressants. Dec 2004 Greenberg WM; Obsessive-Compulsive Disorder. emedicine. Updated: May 31, 2009 EMIS 2010, as distributed on Obsessive-Compulsive-Disorder.htm Used with permission.

A Guide to Cognitive- Behavioural Therapy (CBT) Cognitive-behavioural Therapy (CBT) aims to help you to change the way that you think, feel and behave. It is used as a treatment for various mental health

DRAFT FOR CONSULTATION The treatment of obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) for adults, children and young people The paragraphs in the draft are numbered for the purposes

Post-Traumatic Stress Disorder (PTSD) Post traumatic stress disorder is a condition where you have recurring distressing memories, flashbacks, and other symptoms after suffering a traumatic event. Treatment

Issue date: November 2005 Treating obsessivecompulsive disorder (OCD) and body dysmorphic disorder (BDD) in adults, children and young people Understanding NICE guidance information for people with OCD

David A. Clark, Ph. D. Sue is a young mother of two children who developed an intense fear of contracting germs that might lead to a life-threatening infectious disease. Much of her day is spent worrying

The Priory Group What is obsessive-compulsive disorder? by Dr David Veale Dr Veale is a Consultant Psychiatrist at the Priory Hospital North London and the coauthor of Overcoming Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) Introduction Obsessive compulsive disorder, or OCD, is a type of anxiety disorder. OCD causes repeated upsetting thoughts called obsessions. To try and get rid of these

Issue date: September 2005 The treatment of depression in children and Understanding NICE guidance information for children and young with depression, their families and carers, and the public Information

Understanding obsessive-compulsive disorder (OCD) understanding obsessive-compulsive disorder Understanding obsessive-compulsive disorder (OCD) This booklet is for anyone who has or thinks they may have

A Guide to Bulimia Nervosa People with bulimia nervosa have episodes of binge eating. This is followed by self-induced vomiting or other measures to counteract the excessive food intake. Treatments include

OcD a guide for young children? come and meet and as they explain what Obsessive-Compulsive Disorder is is the leading national charity, independently working with and for young people affected by Obsessive

The treatment of post-traumatic stress disorder (PTSD) in adults and children Understanding NICE guidance information for people with PTSD, their advocates and carers, and the public The paragraphs are

When Unwanted Thoughts Take Over: Obsessive-Compulsive Disorder National Institute of Mental Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Mental

Making sense of cognitive behaviour therapy (CBT) Making sense of cognitive behaviour therapy What is cognitive behaviour therapy? 4 How does negative thinking start? 6 What type of problems can CBT help

Patient information from the BMJ Group Depression in children and adolescents Depression is an illness that affects people of all ages, including children and teenagers. It can stop a child or teenager

Obsessive- Compulsive Disorder: When Unwanted Thoughts Take Over Do you feel the need to check and re - check things over and over? Do you have the same thoughts constantly? Do you feel a very strong need

South London and Maudsley NHS Foundation Trust Centre for Anxiety Disorders and Trauma Information for service users Who we are We are a psychological therapy service for adults based at the Maudsley Hospital.

When Unwanted Thoughts Take Over: Obsessive-Compulsive Disorder National Institute of Mental Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Mental

Treatments for Anxiety This leaflet explains some of the symptoms of anxiety as well as the options for treating it. Children and Families Community Services Mental Health Secure Services Specialist Services

Methodist Assistance Program Anxiety, Panic and Other Disorders Anxiety, panic and other disorders such as agoraphobia, social phobia, compulsive disorder and posttraumatic stress disorder are all very

Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children Understanding NICE guidance information for people with PTSD, their advocates and carers, and the public March 2005 Information

Supporting Disabled Members in the workplace Mental Health Issues This briefing has been developed to help reps who are supporting members with mental health issues. Mental health problems include stress,

alzheimers.org.uk Depression and anxiety Depression and anxiety are common conditions that are frequently experienced by people with dementia and their carers. They are known as psychological conditions

A Patient Information Guide Depression and Antidepressants This guide aims to outline why antidepressants (or other treatments) may be recommended by your doctor and also provides information about how

Using antidepressants in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

Helping Children and Youth with Obsessive-Compulsive Disorder (OCD): Information for Parents and Caregivers He just can t stop washing William enjoys hanging out with his friends and family, and is a great

NHS National Institute for Health and Clinical Excellence Issue date: February 2006 Computerised cognitive behaviour therapy for Understanding NICE guidance information for people with depression and anxiety,

Psychological support for adults living with HIV Everyone living with HIV is entitled to specialist psychological support Although many people living with HIV do not have psychological problems, specialist

Antidepressant Medicines UHN Information for patients and families Read this booklet to learn: what antidepressant medicines are how they work possible side effects important points to remember The name

Treating social anxiety disorder A Copyright Harvard Health Publications Cognitive behavioral therapy is effective for most patients, while medication strategies depend on whether the disorder is generalized

The Family Library DEPRESSION What is depression? Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too. Also called

A Guide to Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

Depression Information for service users and carers RDaSH Adult Mental Health Services Depression is a very common problem. It can affect anyone, regardless of your age, personality, culture, social or

Understanding anxiety and depression www.beyondblue.org.au 1300 22 4636 Anxiety Over two million people in Australia experience anxiety each year. On average, one in three women and one in fve men will

Obsessive Compulsive Disorder What you need to know to help your patients By Renae M. Reinardy, PsyD, LP, and Jon E. Grant, MD Obsessive compulsive disorder (OCD) is a condition that affects millions of

CLASS OBJECTIVE: What is Obsessive-Compulsive Disorder? Chapter 4-Anxiety Disorders What is OCD? Obsessive-compulsive disorder is an anxiety disorder that involves unwanted, What Did you see? The obsessions

Depression & Multiple Sclerosis Managing Specific Issues Feeling blue The words depressed and depression are used so casually in everyday conversation that their meaning has become murky. True depression

TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than

Anxiety and are common in people with asthma. The good news is that there are effective treatments both for asthma and for anxiety and. With careful management, the symptoms of anxiety and can be treated

Anxiety Disorders TASK: Recognize warning signs and symptoms of Anxiety Disorders. STANDARDS: Soldiers will understand how recognize signs of anxiety and better assist others when one may be having symptoms

MENTAL HEALTH OBSESSIVE COMPULSIVE DISORDER WHAT IS OBSESSIVE COMPULSIVE DISORDER? Obsessive compulsive disorder (OCD) is an anxiety disorder that usually develops in adolescence or young adulthood. However,

Non-epileptic seizures a short guide for patients and families Information for patients Department of Neurology Royal Hallamshire Hospital What are non-epileptic seizures? In a seizure people lose control

TASK: Recognize warning signs and symptoms of Anxiety Disorders. STANDARDS: Soldiers will understand how recognize signs of anxiety and better assist others when one may be having symptoms or showing signs

Psychological Treatments Talking Therapies This leaflet gives a brief guide to some of the different talking therapies. It also suggests who might benefit from them Children and Families Community Services

Making sense of CBT Making sense CBT Making sense of CBT This booklet is for anyone who wants to know more about cognitive behavioural therapy (CBT). It explains what it is, what it helps with, what happens

Post-Traumatic Stress Disorder - PTSD Introduction Post-Traumatic Stress Disorder, or PTSD, is a common disorder in which a person experiences disabling anxiety after a traumatic event. People with PTSD

Worried about someone s mental health? This factsheet can help you if you are worried about the mental health of a friend, relative or loved one. It explains what you can do and where to go to get help

Obsessive Compulsive Disorder A woman visits her dermatologist, complaining of extremely dry skin and seldom feeling clean. She showers for two hours every day. A lawyer insists on making coffee several

What is Alzheimer s disease? Contents 03 What is Alzheimer s? What is dementia? 04 Symptoms 06 Diagnosis 08 Treatments This introductory booklet aims to provide an overview of Alzheimer s disease. It is

Antidepressants are drugs used, most often, to treat depression. Depression is a complex illness that involves sad and hopeless feelings that do not go away. Doctors sometimes order these drugs for other

Post-traumatic stress disorder (PTSD) This factsheet has information about the symptoms and causes of posttraumatic stress disorder (PTSD). It says who might get PTSD and what treatment is available. You

Treatments for Depression This leaflet contains information about depression and how it can be treated Children and Families Community Services Mental Health Secure Services Specialist Services Adult Mental

Cognitive and behavioural therapy (CBT) for people with depression and anxiety What skills can service users expect their therapists to have? Cognitive and behavioural therapy (CBT) for people with depression

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES Psychological therapies are increasingly viewed as an important part of both mental and physical healthcare, and there is a growing demand for

Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT? Open Learning Agency 2004 WHAT IS IT? Anxiety is a normal human feeling characterized by worry, nervousness and fear. Not only does anxiety

Obsessive Compulsive Disorder (OCD) Fact sheet 37 What is OCD? Anxious thoughts can influence our behaviour and this is helpful at times. For example, the thought I may have left the oven on leads to the

Anxiety Providing services we would be happy for our own families to use An information guide for Anxiety This booklet aim to: Give you an understanding of Anxiety, it s causes and symptoms Provide information

Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases

Understanding phobias understanding phobias Understanding phobias This booklet is for anyone who has a phobia, and their friends and family. It describes what phobias are, how they make you feel and what

obsessive compulsive disorder an information guide for young people is the leading national charity, independently working with and for young people affected by Obsessive Compulsive Disorder (OCD) Registration

Management of moderate to severe ere (including psychotic) depression in children and young people tiers 2 4 bring together all NICE guidance, quality standards and other NICE information on a specific

Overcome Fear and Anxiety Fear is one of the most powerful emotions. It has a very strong effect on your mind and body. Fear tells you what to do in emergencies, like a fire or being attacked. It can also

What Dads and Mums need to know Postnatal anxiety and depression What Dads and Mums need to know 1 Postnatal Depression and Anxiety Feelings and emotions after birth Having a baby can be an exciting time,

Making sense of psychiatric medication making sense psychiatric medication Making sense of psychiatric medication This booklet is for anyone who wants to know more about psychiatric medication. It explains

Published on Epilepsy Action (https://www.epilepsy.org.uk) Page generated on 20/05/2014 Epilepsy and depression In this section Introduction About depression Causes of depression Epilepsy and depression

Post-traumatic stress disorder overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

Tool Kit for Childhood & Adolescent Anxiety Management Tool Kit for Management of Childhood & Adolescent Anxiety The clinical tool kit is intended to assist the PCP in assessing the needs of the child/adolescent,

Understanding NICE guidance Information for people who use NHS services Bipolar disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments